As the Division of Developmental Disabilities (DDD) continues to implement the Guidehouse Rate Study recommendations, there has been a focus on the ICAP data the Community Integrated Living Arrangement (CILA) Rates Unit is utilizing to calculate individual CILA rates both currently and with the implementation of a rate calculator scenario in the future.

In an effort to ensure DDD has the most accurate ICAP score on file for purposes of calculating each 24-hour CILA resident’s rate effective July 1, 2024, DDD will be utilizing the process outlined below for the collection of all 24-hour CILA ICAPs. DDD requests the collaboration and partnership of all Independent Service Coordination (ISC) Agencies and provider agencies to help ensure all ICAPs for the clinical eligibility portion of Medicaid Redeterminations due before July 1, be completed and submitted to DDD, and that ISC agencies and provider agencies collaborate to work out any discrepancies between ICAP scores for all other 24-hour CILA residents and submit those to DDD as well. All ICAP scores are required to be submitted to DDD by June 15, 2024.

  • DDD will mail CILA provider agencies a list of the individuals DDD has on file who are funded for and receiving 24-hour CILA and the corresponding ICAP scores for each individual, as has been submitted by the ISC agencies to DDD via the most recent clinical eligibility portion of the Medicaid Redetermination process for each CILA resident they serve. These ICAP scores were collected by DDD from the ISC agencies in October 2023 and reflect Medicaid redeterminations completed between September 2022 and October 2023.
    • NOTE: The ICAP scores found on the recently distributed CILA rate summary sheets are the ICAP scores on file with the DDD CILA Rates Unit which were used to calculate January 1, 2024 rates and are not the same as the ICAP scores completed and submitted via the clinical eligibility portion of the Medicaid Redetermination process.
  • CILA provider agencies should work with their ISC agency or agencies to review all 24 Hour CILA resident ICAP scores and identify those that show a difference between the provider agency’s most recent ICAP and the ISC agency’s most recent ICAP.
    • For those Medicaid Redeterminations for CILA participants that will come due between March 1, 2024, and June 30, 2024, provider agencies should work with their ISC agencies as the clinical eligibility portion of the Medicaid Redetermination process is completed to discuss and complete/update the ICAP as needed to accurately reflect an individual’s needs.
    • For those Medicaid Redeterminations that have already occurred in Fiscal Year 2024 (July 1, 2023, through March, 2024), provider agencies and ISC agencies should work together to review and discuss all ICAPs. For any CILA resident for which there is a concern that their most recent ICAP is not accurately reflecting their needs, the ISC agency will work with the provider agency to complete a new ICAP.
    • DDD is working on a process for the ISC agencies to submit all ICAPs to DDD. That process will be communicated as soon as possible. All ICAPs will be required to be submitted through the DDD designated process by June 15, 2024.
  • For purposes of the above process, no supporting documentation will be required to be submitted to DDD should an individual’s ICAP score change by more than 9 points, however, DDD reserves the right to follow-up in situations in which there are questions about a score change.
  • Effective as of the date of this DDD Communication, DDD will not accept nor process any ICAPs submitted through the turnaround form process. DDD will process all ICAPs received prior to today’s date. Moving forward, only those ICAPs submitted through the ISC agencies via the clinical eligibility portion of the Medicaid Redetermination and this special process will be utilized for rate setting purposes.
  • ICAP forms must still be included in all new CILA packets and Rate Redetermination packets submitted to DDD.

Post-July 1, 2024, DDD is developing a process to streamline the reviewing and updating of the ICAP scores submitted by the ISC agencies. The plan is for the ICAP scores collected via the clinical eligibility portion of the Medicaid Redetermination process to be collected in one place. DDD will then use those scores to update/inform rates semiannually, each January and July, at the same frequency as the Health Risk Screening Tool (HRST) scores are updated with DDD.

More information on both processes, including the release of a DRAFT Information Bulletin, will be forthcoming.